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What We’re Reading: Unauthorized ACA Plan Switching; Private Equity in Emergency Care; MA Payments Cut
Insurance plan members find themselves involuntarily switched between plans; the Senate investigates patient safety concerns resulting from private equity practices; base payments to Medicare Advantage (MA) plans will decrease in 2025.
ACA Enrollees Encounter Unauthorized Plan Switching
Affordable Care Act (ACA) enrollees are experiencing unauthorized plan-switching disruptions to their coverage, driven by rogue agents exploiting vulnerabilities in federal marketplace security, according to Kaiser Health News. Despite record enrollment, complaints have surged, prompting regulatory actions from CMS, yet the efficacy of these measures remains uncertain. Additionally, brokers have reported ongoing concerns amidst new consent rules, highlighting the urgent need for enhanced safeguards to protect consumers and maintain ACA integrity.
Senate Committee Probes Private-Equity Firms' Impact on ED Care
Senator Gary Peters (D, Michigan) is heading a Senate inquiry into private-equity firms' management of hospital emergency departments, prompted by reports of patient safety and care issues, according to NBC News. Requests for information targeted Apollo Global Management, the Blackstone Group, and KKR, along with affiliated companies, aiming to assess the impact of private-equity practices on health care quality and physician autonomy. As private-equity firms increasingly dominate the health care sector, concerns continue to mount over cost-saving measures that potentially compromise patient safety, which have prompted calls for transparency and accountability from industry stakeholders.
Biden Administration Cuts MA Payments
The Biden administration's decision to reduce base payments to Medicare Advantage (MA) plans by an average of 0.16% has triggered a market downturn for major insurers like UnitedHealth, CVS Health, Humana, and Centene, amidst fears of ongoing financial challenges, according to Axios. While risk-adjusted payments may mitigate the impact, insurers expressed worries over continued pressure on seniors' benefits and potential benefit reductions due to rising costs and policy changes. With MA enrollment surging, concerns persist over overpayment and cost escalation.
Despite Record ACA Enrollment, Report Reveals Underinsured Americans are in Crisis
November 21st 2024Despite significant progress in expanding health insurance coverage since the Affordable Care Act (ACA) was enacted, millions of Americans still face critical gaps in access and affordability to health care.
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Bridging the Vaccination Gap: Insights on Global Immunization Challenges
July 30th 2024On this episode of Managed Care Cast, we speak with Jeffery A. Goad, PharmD, MPH, 2024-2025 president of the National Foundation for Infectious Diseases, on the recent report from the World Health Organization and UNICEF on public immunization rates, with national and global health implications.
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Uniting to Support Patients With Cancer Beyond Treatment
November 17th 2024Kasey Bond, MPH, of Perlmutter Cancer Center at NYU Langone Health, speaks to why it’s vital to keep patients at the center of all strategic partnerships between academic institutions and community-based oncology practices.
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Double Trouble: High-Deductible Plans Raise Maternity Care Costs Across 2 Calendar Years
June 27th 2024On this episode of Managed Care Cast, we're talking with the author of a study published in the June 2024 issue of The American Journal of Managed Care® about how annual high-deductible insurance plans increase maternity care costs when pregnancies cross 2 calendar years.
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